Healthcare Provider Details

I. General information

NPI: 1881724870
Provider Name (Legal Business Name): HOFF MEDICAL CLINIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 02/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1702 N KINGSHIGHWAY ST
CAPE GIRARDEAU MO
63701-2122
US

IV. Provider business mailing address

1702 N KINGSHIGHWAY ST
CAPE GIRARDEAU MO
63701-2122
US

V. Phone/Fax

Practice location:
  • Phone: 573-339-2000
  • Fax: 573-339-1876
Mailing address:
  • Phone: 573-339-2000
  • Fax: 573-339-1876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR7G45
License Number StateMO

VIII. Authorized Official

Name: MR. GERRY KEENE
Title or Position: MANAGER
Credential:
Phone: 573-339-2000